| NPI | 1699720342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002818A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001201A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001509A) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2015-03-03 |